Prostate-Specific Membrane Antigen (PSMA) Expression Predicts Need for Early Treatment in Prostate Cancer Patients Managed with Active Surveillance.

Metabolic dysregulation is an early event in carcinogenesis. Here, we examined the expression of enzymes involved in de novo lipogenesis (ATP-citrate lyase: ACLY), glucose uptake (Glucose Transporter 1: GLUT1), and folate-glutamate metabolism (Prostate-Specific Membrane Antigen: PSMA) as potential biomarkers of risk for early prostate cancer progression. Patients who were managed initially on active surveillance with a Gleason score of 6 or a low-volume Gleason score of 7 (3 + 4) were accrued from a prostate cancer diagnostic assessment program. Patients were asked to donate their baseline diagnostic biopsy tissues and permit access to their clinical data. PSMA, GLUT1, and ACLY expression were examined with immunohistochemistry (IHC) in baseline biopsies, quantitated by Histologic Score for expression in benign and malignant glands, and compared with patient time remaining on active surveillance (time-on-AS). All three markers showed trends for elevated expression in malignant compared to benign glands, which was statistically significant for ACLY. On univariate analysis, increased PSMA and GLUT1 expression in malignant glands was associated with shorter time-on-AS (HR: 5.06, [CI 95%: 1.83-13.94] and HR: 2.44, [CI 95%: 1.10-5.44], respectively). Malignant ACLY and benign gland PSMA and GLUT1 expression showed non-significant trends for such association. On multivariate analysis, overexpression of PSMA in malignant glands was an independent predictor of early PC progression (p = 0.006). This work suggests that the expression of metabolic enzymes determined by IHC on baseline diagnostic prostate biopsies may have value as biomarkers of risk for rapid PC progression. PSMA may be an independent predictor of risk for progression and should be investigated further in systematic studies.

Risky Business: Factors That Increase Risk of Falls Among Older Adult In-Patients.

In hospitals, older patients are at increased risk of falling multiple times. This study incorporated an epidemiologic cross-sectional design consisting of 4,348 older patients (≥65-year-old). Eight hundred eighty five (20.4%) in-patients experienced multiple falls while remaining participants had one fall incident. A patient fall event was recorded with age, sex, incident date, type of fall, and location. Logistic regression assessed risk factors found in patients with multiple falls compared to those with one fall. Significant differences were observed in the proportion of multiple falls: in a bed with no rails, standing, walking, and using a wheel/Geri chair (p < .05). Overall, sex, type of fall, and location were significant in predicting multiple falls (p < .05). Male patients were at 16.1% greater risk of multiple falls, when compared to females (p < .05). A fall in complex care, mental health, or respirology were more likely to experience multiple falls (OR = 2.659, 3.620, 1.593 respectively), while season had no impact.

What Factors Increase Odds of Long-Stay Delayed Discharge in Alternate Level of Care Patients?

OBJECTIVE: The objective of this study was to determine the factors that increase the odds of long-stay delayed discharge in alternate level of care (ALC) patients using data collected from the Ontario Wait Time Information System (WTIS) database. DESIGN: Retrospective cohort study utilizing data from Niagara Health's WTIS database. WTIS includes individuals admitted to any of the Niagara Health sites that have been designated as ALC. SETTING AND PARTICIPANTS: Sample consisted of 16,429 ALC patients who received care in Niagara Health hospitals from September 2014 to September 2019 and were recorded in the WTIS database. METHODS: ALC designation of 30 or more days was used as the threshold for a long-stay delayed discharge. This study used binary logistic regression modeling to analyze sex, age, admission source, and discharge destination as well needs/barriers requirements to assess the likelihood of a long-stay delayed discharge among acute care (AC) and post-acute care (PAC) patients given the presence of each variable. Sample sizes calculations and receiver operating characteristic curves were used to verify the validity of the regression model. RESULTS: Overall, 10.2% of the sample were considered long-stay ALC patients. Both AC and PAC long-stay ALC patients were more likely to be male [OR = 1.23, (1.06-1.43); OR = 1.28, (1.03-1.60)] and have a discharge destination of a long-term care bed [OR = 28.68, (22.83-36.04); OR = 6.22, (4.75-8.15)]. AC patients had bariatric [OR = 7.16, (3.45-14.83)], behavioral [OR = 1.89, (1.22-2.91)], infection (isolation) [OR = 2.31, (1.63-3.28)], and feeding [OR = 6.38, (1.82-22.30)] barriers hindering discharge. PAC patients had no significant barriers hindering patient discharge. CONCLUSIONS AND IMPLICATIONS: Shifting the focus from ALC patient designation to short- vs long-stay ALC patients allowed this study to focus on the subset of patients that are disproportionately affecting delayed discharges. Understanding the importance of specialized patient requirements in addition to clinical factors can help hospitals become more prepared in preventing delayed discharges.

Contemporary nutrition-based interventions to reduce risk of infection among elderly long-term care residents: A scoping review.

BACKGROUND: Elderly long-term care residents (ELTCRs) face considerable burden of infection, especially evident during the COVID-19 pandemic. The nutritional status of the host can influence susceptibility to infection by altering immune system integrity, therefore, nutrition-based interventions may be a viable complement to existing infection prevention measures. OBJECTIVE: This scoping review sought to identify nutritional interventions and factors that have the strongest evidence to benefit ELTCRs, and thus best poised for rigorous clinical trial evaluation and subsequent implementation. METHODS: A database search of OVID-Medline, OVID-Embase, and Web of Science was performed from 2011 to 2021 to identify nutritional intervention studies which attribute to changes in infection in contemporary ELTCR settings. Articles were screened in duplicate and data extraction completed by a single reviewer, while a second reviewer verified the data which was fitted to identify evidence for nutritional interventions related to reducing rates of infection among ELTCRs. RESULTS: The search identified 1018 studies, of which 11 (nine clinical trials and two observational cohort studies) satisfied screening criteria. Interventions that significantly reduced risk of infection included whey protein (any infection), Black Chokeberry (urinary tract infection), and vitamin D (acute respiratory tract infection, skin and soft tissue infection). Both zinc and a dedicated meal-plan significantly improved lymphocyte parameters. Vitamin D deficiency was associated with the development of respiratory tract infections. Probiotic and soy-based protein interventions did not significantly affect risk of infection or lymphocyte parameters, respectively. CONCLUSION: The current scoping review was effective in identifying the use of nutrition-based interventions for infection prevention among ELTCRs. In this study, some nutrition-based interventions were observed to significantly influence the risk of infection among ELTCRs. Nutritional interventions such as vitamin D (preventing deficiency/insufficiency), Black Chokeberry juice, zinc gluconate, whey protein, and varied and nutrient dense meal plans may be suitable for future rigorous clinical trial evaluation.

Impact of a multifaceted and multidisciplinary intervention on pain, agitation and delirium management in a Canadian community intensive care unit: a quality improvement study protocol.

BACKGROUND: Pain and agitation are closely linked to the development of delirium, which affects 60%-87% of critically ill patients. Delirium is associated with increased mortality and morbidity. Clinical guidelines that suggest routine assessment, treatment and prevention of pain, agitation and delirium (PAD) is crucial to improving patient outcomes. However, the adoption of and adherence to PAD guidelines remain suboptimal, especially in community hospitals. The aim of this quality improvement study is to evaluate the impact of a multifaceted and multidisciplinary intervention on PAD management in a Canadian community intensive care unit (ICU). METHODS: This is a quality improvement, uncontrolled, before-and-after study of a multifaceted and multidisciplinary intervention targeting nurses (educational modules, visual reminders), family members (interviews, educational pamphlets and an educational video), physicians (multidisciplinary round script) and the multidisciplinary team as a whole (delirium poster). We will collect data every day for 6 weeks before implementing the intervention. Data collection will include clinical information and information on process of care. We will then implement the intervention. Four weeks after, we will collect data daily for 6 weeks to evaluate the effect of the intervention. On the basis of the volume of the ICU, we expect to enroll approximately 280 patients. We have obtained local ethics approval from the Hamilton Integrated Research Ethics Board (HiREB 18-040-C). INTERPRETATION: The results of this quality improvement study will provide information on adherence to PAD guidelines in a Canadian community ICU setting. They will also supply information on the feasibility of implementing multifaceted and multidisciplinary PAD interventions in community ICUs.

The longitudinal relationship between generalized self-efficacy and physical activity in school-aged children.

Our understanding of the longitudinal relationship between generalized self-efficacy (GSE) and physical activity in children and youth is limited. The purpose of this study was to investigate the effect of GSE towards physical activity on sedentary behaviours and physical activity in school-aged children over time. A total of 2278 nine-year-old children (1120 girls and 1158 boys) were recruited at baseline and followed for seven waves of data collection from 2005 to 2008. All children completed questionnaires at each wave assessing their GSE (adequacy, predilection, and enjoyment), sedentary behaviours, free play, and organized activity. Mixed-effects models were used to estimate changes in physical activity and GSE within individuals over time, controlling for gender and motor ability. The results showed that participation in free play significantly increased over time, whereas organized activity significantly decreased over the same period. Children with high perceived adequacy and predilection had higher free play and organized activity participation relative to other children over time. However, the effect of perceived adequacy diminished over time, while the gaps between groups with different levels of predilection widened over time. While sedentary behaviours were lower over time in children with high predilection, these behaviours were consistently higher in children with high enjoyment. The differences in sedentary behaviours between groups increased over time for both predilection and enjoyment. This study highlights the importance of different components of GSE on physical activity participation. In addition, interventions targeting the enhancement of predilection may facilitate physical activity and reduce sedentary behaviours.

Tracking cardiorespiratory fitness and physical activity in children with and without motor coordination problems.

OBJECTIVES: Previous research has shown children with Developmental Coordination Disorder (DCD) have lower cardiorespiratory fitness (CRF) than typically developing (TD) children. This has been hypothesized to be due to an activity deficit, whereby poor motor functioning discourages children from participating in physical activities, but this hypothesis has not been directly tested. In this study, we use longitudinal data to measure the extent to which physical activity explains differences in CRF between children with and without motor coordination deficits. DESIGN: Longitudinal observational study. METHODS: The study sample is an open cohort of children, numbering 2278 at baseline (age 9-10), that was followed for up to 5 years (to age 13-14). Motor skills were assessed once over the study period. Children scoring at or below the 5th percentile (n=103) on the Bruininks-Oseretsky Test of Motor Proficiency-Short Form were considered to have possible DCD (pDCD). CRF (estimated peak VO2) was estimated from performance on the Léger 20m shuttle run test, and physical activity was measured with the Participation Questionnaire. Both fitness and physical activity were measured up to 7 times over the study period. RESULTS: Children with pDCD had significantly lower CRF than their TD peers at each time point. CRF declined for both groups, but this decline was steeper for children with pDCD. Physical activity explained only a small part of the difference in CRF. CONCLUSIONS: The activity deficit did not contribute to the persistent and gradually widening gap in CRF between children with and without possible DCD. Possible reasons for this and future directions are discussed.

Arterial stiffness in children with and without probable developmental coordination disorder.

BACKGROUND: Children with cardiovascular disease risk factors demonstrate adverse arterial alterations that are predictive of cardiovascular morbidity and mortality in adults. Children with developmental coordination disorder (DCD) are at cardiovascular risk as they are more likely to be obese and inactive. AIM: The purpose of this study was to assess arterial structure and function in children with and without probable DCD (p-DCD). METHODS: A cross-sectional study of 33 children with p-DCD (22 male) and 53 without (30 male). The Movement Assessment Battery for Children was used to classify those with p-DCD. Adiposity was assessed using the BOD POD. Compliance, distensibility, and intima-media thickness were measured at the common carotid artery (CCA). ECG R-wave-to-toe pulse wave velocity (PWV) was also measured. RESULTS: Compared to controls, males with p-DCD had lower CCA distensibility (p=0.034) and higher PWV (p=0.001). No differences were evident in females. Body fat percent was a significant predictor of CCA distensibility and removed the effect of p-DCD on PWV in males. CONCLUSIONS: The present study demonstrates augmented arterial stiffness in males with p-DCD, likely attributed to body fat. These findings underscore the importance of targeted interventions in children with p-DCD, specifically males, in order to prevent future cardiovascular risk.

Longitudinal examination of objectively-measured physical activity and sedentary time among children with and without significant movement impairments.

BACKGROUND: Children with Developmental Coordination Disorder (DCD) tend to be less active than typically-developing (TD) children. Current evidence, however, is based on cross-sectional and self-reported activity, and little is known about sedentary time among children with significant movement impairments such as DCD. The current study examines the longitudinal patterns of objectively measured physical activity and sedentary time in children with and without possible DCD (pDCD). METHODS: Data is from a longitudinal nested case-control study, with 103 participants (n=60 males ages=12 and 13 at baseline). Participants averaging ⩽16th percentile on the Movement Assessment Battery for Children were considered having significant movement impairments and pDCD (n=49). All participants wore accelerometers for seven days. RESULTS: There were significant main effects for time (Estimate=-23.98, p<.01) and gender (Estimate=59.86, p<.05) on total physical activity, and time spent being sedentary (Estimate=15.58, p<.05). Significant main effects for pDCD (Estimate=-5.38, p<.05) and gender (Estimate=26.89, p<.01), and time by gender interaction (Estimate=-7.50, p<.05) were found for moderate-to-vigorous physical activity (MVPA). Sedentary time did not differ between children with and without DCD. CONCLUSIONS: Results suggest children with pDCD engaged in less MVPA compared to TD children. Consistent patterns of MVPA over time, however, suggest that the divergence in MVPA occurs earlier in childhood. Further longitudinal research following a younger cohort is necessary to identify the specific point that differences in MVPA emerge.

Reprint of "Relationship between BMI, waist circumference, physical activity and probable developmental coordination disorder over time".

BACKGROUND: Cross-sectional studies have shown that children with developmental coordination disorder (DCD) are less likely to be physically active and have excess weight gain. However, longitudinal studies examining the relationship between DCD and measures of body composition (BMI and waist circumference) over time are lacking. It is not known if sex and physical activity affect the relationship between DCD and measures of body composition over time. OBJECTIVE: (1) To examine if BMI and waist circumference in children with and without probable DCD (pDCD) remain constant over time or change as children age, and whether this relationship varies by sex. (2) To examine if differences in physical activity between children with and without pDCD account for differences in BMI and waist circumference over time. METHODS: Physical Health Activity Study Team (PHAST) data were used for this longitudinal analysis. At baseline, a total of 2,278 (pDCD = 103) children aged 9-10 years were included in the analysis. The total follow-up period was five years. Mixed-effects modeling was used to estimate change in body composition measures in children over time. RESULTS: Children with pDCD have higher BMI and waist circumference compared to typically developing children, and this difference increased over the study period. The relationship between pDCD and BMI over time also varied by sex. A similar trend was observed for waist circumference. Boys with pDCD were found to have a more rapid increase in BMI and waist circumference compared to girls with pDCD. Physical activity had neither a mediating nor a moderating effect on the relationship between pDCD and measures of body composition. However, physical activity was independently and negatively associated with measures of body composition. CONCLUSIONS: pDCD is associated with higher body mass and waist circumference, both important risk factors for cardiovascular disease, type 2 diabetes, and psychological problems and other health conditions.

Relationship between BMI, waist circumference, physical activity and probable developmental coordination disorder over time.

BACKGROUND: Cross-sectional studies have shown that children with developmental coordination disorder (DCD) are less likely to be physically active and have excess weight gain. However, longitudinal studies examining the relationship between DCD and measures of body composition (BMI and waist circumference) over time are lacking. It is not known if sex and physical activity affect the relationship between DCD and measures of body composition over time. OBJECTIVE: (1) To examine if BMI and waist circumference in children with and without probable DCD (pDCD) remain constant over time or change as children age, and whether this relationship varies by sex. (2) To examine if differences in physical activity between children with and without pDCD account for differences in BMI and waist circumference over time. METHODS: Physical Health Activity Study Team (PHAST) data were used for this longitudinal analysis. At baseline, a total of 2,278 (pDCD=103) children aged 9-10 years were included in the analysis. The total follow-up period was five years. Mixed-effects modeling was used to estimate change in body composition measures in children over time. RESULTS: Children with pDCD have higher BMI and waist circumference compared to typically developing children, and this difference increased over the study period. The relationship between pDCD and BMI over time also varied by sex. A similar trend was observed for waist circumference. Boys with pDCD were found to have a more rapid increase in BMI and waist circumference compared to girls with pDCD. Physical activity had neither a mediating nor a moderating effect on the relationship between pDCD and measures of body composition. However, physical activity was independently and negatively associated with measures of body composition. CONCLUSIONS: pDCD is associated with higher body mass and waist circumference, both important risk factors for cardiovascular disease, type 2 diabetes, and psychological problems and other health conditions.

When and for whom are relative age effects important? Evidence from a simple test of cardiorespiratory fitness.

OBJECTIVES: When individuals of different ages are combined into a single group and an ability that varies with age is measured, younger individuals are disadvantaged. This phenomenon is known as a relative age effect (RAE) and has been shown to be widespread in sport and education. METHODS: In this article, we examine RAEs in a large group of children tested repeatedly on the 20-m shuttle run, a common test of cardiorespiratory fitness. Following up on an earlier study that measured change with age, we add a growth curve model for change in variance, which makes it possible to derive RAEs for individuals of different ages and ability levels. RESULTS: Results show that a 1-year difference in age is associated with a change in performance of about 0.2 standard deviations. For 1-year age groups, this gives rise to ranking errors of 4 percentile ranks or less. We also show, however, that these relatively small ranking errors are capable of producing large age differences within groups identified as exceptional. Depending on the level of ability required for selection, children born in the first quarter of the year can be expected to outnumber those born in the last by 1.5 times, 2 times, or more. This finding is consistent with previously reported variation in RAEs at different performance levels. CONCLUSIONS: Results imply that RAEs are likely to be of relatively minor concern when people are graded or ranked but can produce substantial inequities and misclassifications when people with extremely high or extremely low ability levels undergo selection.

Associations between family eating behaviours and body composition measures in peri-adolescents: results from a community-based study of school-aged children.

OBJECTIVES: To identify key eating behaviours in children and their parents and to determine the associations between these behaviours and measures of body composition in children. METHODS: Data were collected on a sample of 431 peri-adolescent children (12.4±0.3 years) and their parents from the Niagara Region. Body composition was assessed by trained research assistants. Eating behaviours were assessed using a revised version of the Family Eating and Activity Habits Questionnaire. Principal component analyses were used to identify key eating behaviours among children, mothers and fathers. Linear regression models were used to assess their associations with body mass index (BMI), waist-to-height ratio, waist-to-hip ratio, waist girth, and hip girth measures in children. RESULTS: Emotional/uncontrolled eating and eating by the television in children and their mothers were positively associated with measures of body composition in children. Other eating behaviours that were associated with larger measures of body composition in children included low frequency of eating meals with parents, frequent sweet beverage consumption and snacking and eating "on-the-go" in children, eating "on-the-go" in mothers, and emotional eating and eating by the television/late at night in fathers. CONCLUSIONS: The eating behaviours of children and mothers, and to a lesser degree fathers, are important predictors of children's body composition. Public health interventions designed to help mothers and children reduce the frequency of emotional/uncontrolled eating and eating by the television may be effective means of facilitating positive weight outcomes in children.

Biological age and sex-related declines in physical activity during adolescence.

INTRODUCTION: Sex differences in the rate of decline in physical activity (PA) are most pronounced during adolescence. However, once boys and girls are aligned on biological age, sex differences in the patterns of PA become attenuated. The aim of this study was to test whether biological maturation can account for sex differences in participation in PA over time from late childhood to early adolescence. METHODS: A prospective cohort of children (N = 2100; 1064 boys) was followed from ages 11 to 14 yr, with repeated assessments of PA and anthropometry. Self-reported participation in organized and free play activities was used to track participation in PA. Biological age was measured using an estimate of years to attainment of peak height velocity. Mixed-effects models were used to test whether controlling for biological age attenuates the effect of chronological age and sex on PA. RESULTS: As expected, the rate of decline in participation in PA was greater for girls than for boys (B = -1.18, P < 0.01). In multivariable analyses, adjusting for biological age completely attenuated the effect of sex and chronological age for participation in free play activities, but not for participation in organized play. Overall, biological age was a stronger predictor of participation than chronological age. CONCLUSIONS: The effect of biological age on sex by chronological age differences may be specific to certain types of PA participation. Given the importance of maturation to participation in activity, it is suggested that public health strategies target biological not chronological age to prevent declines in PA during adolescence particularly when promoting habitual or lifestyle activity.

Does relative body fat influence the Movement ABC-2 assessment in children with and without developmental coordination disorder?

Developmental coordination disorder (DCD) is a condition that results in an impairment of gross and/or fine motor coordination. Compromised motor coordination contributes to lower levels of physical activity, which is associated with elevated body fat. The impact of elevated body fat on motor coordination diagnostic assessments in children with DCD has not been established. The purpose of this study was to determine if relative body fat influences performance on the Movement Assessment Battery for Children, 2nd Edition (MABC-2) test items in children with and without DCD. A nested case-control, design was conducted within the Physical Health Activity Study Team longitudinal cohort study. The MABC-2 was used to assess motor coordination to categorize cases and matched controls. Relative body fat was assessed using whole body air displacement plethysmography. Relative body fat was negatively associated with the MABC-2 "balance" subcategory after adjusting for physical activity and DCD status. Relative body fat did not influence the subcategories of "manual dexterity" or "aiming and catching". Item analysis of the three balance tasks indicated that relative body fat significantly influences both "2-board balance" and "zig-zag hopping", but not "walking heel-toe backwards". Children with higher levels of relative body fat do not perform as well on the MABC-2, regardless of whether the have DCD or not. Dynamic balance test items are most negatively influenced by body fat. Health practitioners and researchers should be aware that body fat can influence results when interpreting MABC-2 test scores.

Submaximal oxygen cost during incremental exercise in children with developmental coordination disorder.

There has been minimal evidence examining the differences in submaximal aerobic power between children with and without probable developmental coordination disorder (pDCD). This is important as most activities of daily living are performed at submaximal levels. The aim of this study was to examine the oxygen cost of work (VO2) performed during an incremental exercise protocol on a cycle ergometer. Subjects with pDCD (n=63) were matched for age and gender to 63 typically developing controls (12-13 years of age) using a nested case-control design. Motor coordination was assessed using the Movement Assessment Battery for Children. Children with pDCD had significantly lower VO2 peak values relative to controls (35.0 vs. 42.9 ml/kg/min, p<0.0001). At the submaximal level, mixed effects modeling demonstrated that, after controlling for relative body fat, and VO2 peak, children with pDCD had consistently greater oxygen cost (VO2 ml/kg/min) compared to controls at any given exercise intensity (p=0.0006). A significant interaction between pDCD and workload indicated that the difference in VO2 at higher workloads is greater than that at lower workloads (p=0.0004). Children with pDCD utilize more oxygen to sustain the same submaximal workload. The implication of these findings is that children with pDCD may experience earlier fatigue than well coordinated individuals when engaging in physical activity.

Understanding physical activity and motivations for children with developmental coordination disorder: an investigation using the theory of planned behavior.

Developmental coordination disorder (DCD) is a neurodevelopmental condition, affecting approximately 5-6% of children. Previous research has consistently found children with DCD being less physically active compared to typically-developing (TD) children; however, the psychosocial factors associated with physical activity for children with DCD are poorly understood. The purpose of this study was to examine how theory-based physical activity cognitions impacts physical activity behaviors for children with and without DCD. Participants included a sample of boys (N=61, Mage=13.25 ±.46) with DCD (n=19) and without DCD (n=42), drawn from a larger prospective cohort study. A questionnaire with psychosocial measures was first administered, and accelerometers were used to assess their physical activity behavior over the subsequent week. Findings indicate that DCD was significantly associated with lower physical activity (F(1,58)=6.51, p<.05), and poorer physical activity cognitions (F(4,56) Wilks Lambda=2.78, p<.05). Meditational analyses found attitudes (B=.23, p<.05) and subjective norms (B=.31, p<.05) partially mediating the relationship between DCD and physical activity. Overall, this study further confirms that the activity deficit that exists among boys with DCD, and that the relationship is partially mediated through some physical activity cognitions. Interventions should target the perceived approval of influential people, and the personal evaluations of physical activity for boys with motoric difficulties. These findings further emphasizes the discrepancy in physical activity that exist between boys with DCD and TD boys, and highlight the need to better understand the psychological factors related to physical activity for children with DCD.

The Association of Sleep Disorder, Obesity Status, and Diabetes Mellitus among US Adults-The NHANES 2009-2010 Survey Results.

To examine the association between sleep disorders, obesity status, and the risk of diabetes in adults, a total of 3668 individuals aged 40+ years from the NHANES 2009-2010 without missing information on sleep-related questions, measurements related to diabetes, and BMI were included in this analysis. Subjects were categorized into three sleep groups based on two sleep questions: (a) no sleep problems; (b) sleep disturbance; and (c) sleep disorder. Diabetes was defined as having one of a diagnosis from a physician; an overnight fasting glucose > 125 mg/dL; Glycohemoglobin > 6.4%; or an oral glucose tolerance test > 199 mg/dL. Overall, 19% of subjects were diabetics, 37% were obese, and 32% had either sleep disturbance or sleep disorder. Using multiple logistic regression models adjusting for covariates without including BMI, the odds ratios (OR, (95% CI)) of diabetes were 1.40 (1.06, 1.84) and 2.04 (1.40, 2.95) for those with sleep disturbance and with sleep disorder, respectively. When further adjusting for BMI, the ORs were similar for those with sleep disturbance 1.36 (1.06, 1.73) but greatly attenuated for those with sleep disorders (1.38 [0.95, 2.00]). In conclusion, the impact of sleep disorders on diabetes may be explained through the individuals' obesity status.

Scope and nature of sudden cardiac death before age 40 in Ontario: a report from the cardiac death advisory committee of the office of the chief coroner.

BACKGROUND: Understanding sudden cardiac death in the young may inform prevention strategies. OBJECTIVE: To determine the scope and nature of sudden death in a geographically defined population. METHODS: We performed a retrospective population-based cohort study in Ontario, Canada, of all sudden cardiac death cases involving persons aged 2-40 years identified from the 2008 comprehensive Coroner database. Of 1741 Coroner's cases, 376 were considered potential sudden cardiac death cases and underwent review. RESULTS: There were 174 cases of adjudicated sudden cardiac death from a population of 6,602,680 persons aged 2-40 years. Structural heart disease was present in 126 cases (72%), 78% of which was unrecognized. There was no identifiable cause of death in 48 cases (28%), representing primary arrhythmia syndromes. The majority of decedents were men (76%) over the age of 18 (90%). The overall incidence of sudden cardiac death increased with age from 0.7/100,000 (2-18 years) to 2.4/100,000 (19-29 years) to 5.3/100,000 (30-40 years) person-years. Persons experiencing sudden cardiac death before age 30 were more likely to have a primary arrhythmia syndrome (odds ratio 2.97; P<.001). The majority of events occurred in the home (72%); 33% of the events in children/adolescents and 9% of the events in adults occurred during reported moderate or vigorous exercise (P = .002). There were no pediatric deaths during organized competitive sports. CONCLUSIONS: The incidence of sudden cardiac death increases with age, typically occurring in a man at rest in the home with unrecognized underlying heart disease or a primary arrhythmia syndrome. Prevention strategies should consider targeting identification of unrecognized structural heart disease and primary arrhythmia syndromes.

Association between body composition and conformity to the recommendations of Canada's Food Guide and the Dietary Approaches to Stop Hypertension (DASH) diet in peri-adolescence.

OBJECTIVE: The role of following the recommendations of Canada's Food Guide (CFG) and the Dietary Approaches to Stop Hypertension (DASH) diet on body composition in children is unknown. The present study assessed how conformity to the recommendations of these diets was associated with BMI, waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), waist girth (WG), hip girth (HG) and risk of overweight in peri-adolescents. DESIGN: CFG and DASH indices were derived from responses to a food questionnaire, with a higher index representing greater conformity to CFG and DASH diet recommendations. Body composition was assessed by trained research assistants. SETTING: Schools within the Niagara region (Ontario, Canada). SUBJECTS: Children (n 1570) aged 12.4 (sd 0.3) years. RESULTS: After adjustment for age to peak height velocity and total physical activity, a higher CFG index was associated with lower WHtR (b = -0.001, 95 % CI -0.002, -0.0004), WHR (b = -0.001, 95 % CI -0.002, -0.001) and WG (b = -0.18, 95 % CI -0.30, -0.07) in girls. No associations were observed in boys. In contrast, a higher DASH index was associated with decreased body composition measures in both genders. Specifically, the DASH index was negatively associated with BMI (girls: b = -0.07, 95 % CI -0.10, -0.04; boys: b = -0.05, 95 % CI -0.08, -0.02), WHtR (girls: b = -0.001, 95 % CI -0.002, -0.001; boys: b = -0.001, 95 % CI -0.002, -0.0004), WHR (girls: b = -0.001, 95 % CI -0.002, -0.001; boys: b = -0.001, 95 % CI -0.001, -0.00004), WG (girls: b = -0.24, 95 % CI -0.31, -0.16; boys: b = -0.15, 95 % CI -0.24, -0.07) and HG (girls: b = -0.15, 95 % CI -0.23, -0.07; boys: b = -0.12, 95 % CI -0.19, -0.04). A higher DASH index was also associated with lower odds of overweight in girls (OR = 0.70, 95 % CI 0.56, 0.87) and boys (OR = 0.76, 95 % CI 0.62, 0.93). CONCLUSIONS: The DASH diet may prevent overweight in peri-adolescents.